Step – 1
Insured intimates AML at least 3 working days prior to hospitalization
as per the format annexed along with the Doctor’s advice for hospitalization,
prescription/ consultation, all tests reports past-medical history and any other
relevant document(s) as requested by AML
Step – 2AML issues an authorization / denial letter to hospital/Nursing
Home for covered services as per policy terms & conditions to network hospital.
Step – 3
Cashless treatment is extended / denied by network hospital based on AML
authorization letter.
Step – 4
At the time of discharge, insured signs the claim form, all the relevant bills &
keeps all original documents including photocopy of ID card with network hospital.
Emergency Admission

Step – 1
Insured approaches network hospital & submits the copy of ID card within 24hrs
of admission.
Step – 2
Network hospital forwards request letter (Annexure) to AML within
24hrs of hospitalization.
Step – 3AML issued an authorization / denial letter for covered services
as per Mediclaim policy terms & conditions.
Step – 4
Cashless treatment is extended / denied by network hospital for covered services
as per the agreement.
Step – 5
At the time of discharge, insured/proposer signs the claim form and all the relevant
bills & keeps all original documents including photocopy of ID card with network
hospital.

“Cashless Service” may be denied in some of the situations as listed
below.

In case of any doubt in the policy terms with respect to the present ailment.

The Ailment/Condition etc. not being covered under the policy.

The Insured amount not being sufficient to cover the hospitalization expenses.

If the request for preauthorization is not received by AML in time.

If the information sent to AML is insufficient to confirm coverage.

In case of a very short stay at the hospital, authorization for Cashless Services
may be denied due to insufficiency of time to process the same.

In Case where certain important clearances cannot be obtained from the insurance
company due to weekends and holidays.

Denial of cashless facility does not mean denial of treatment & does not stop
the insured from getting necessary medical attention or hospitalization, it means
that the insured will have to pay all charges at the hospital. Insured may
send all related documents in original & lodge claim with us for reimbursement.
The claim will be processed as per terms & conditions of the policy.